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Radiation Risks

With all the talk about the accumulation of medical radiation being a cancer risk, I sometimes wonder about all the x-rays taken to assess RA progression. An initial appointment with a rheumatologist usually includes base-line x-rays. Additional x-rays are taken routinely every couple years, plus extras whenever something concerning occurs.

Someone commented to me the other day that I should be worried that all those x-rays I’ve gotten might cause cancer. My response was that if the people with medical training aren’t worried about it, why should I be?!

I wondered how much risk there really is, and discovered a great way to find out. There’s a website with a radiation risk calculator. Compile a list of all the x-rays, CT scans, fluoroscopy (barium swallows), nuclear medicine studies, and angiograms that you’ve had over the years, enter all the exams into the risk calculator, and your results will easily display.

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9 thoughts on “Radiation Risks”

Interesting. I guess it leaves me to wonder why I have not kept track. I should start. My Rhuemy asks only a couple times a year for xrays, but it is blood work every couple of months. (I should just give blood while I am at it.)

I am seriously scared to find out how all my radiation has made me at risk for more cancer. I may take a peek at the website but I don’t know that I want to know how much my risk has increased due to all the CT scans to follow up on the lung spots, etc.

I’ve probably been exposed to more radiation in the last two years than I was in the 10 years previously. But no one, not even my rheumatologist, has sent me for x-rays of my joints. Odd, eh? My PCP sent me for a routine chest x-ray about a year ago, and I’ve had several mammograms (ouchouchouchouch!) and a breast MRI when they found a lump in my left breast (it was benign, thank goodness). And I had that recent bone density scan. But nothing regarding joints at all.

Thanks, as always, for the information about medical radiation risks. You do some excellent research, m’dear.

@Lana – A couple times a year seems like a lot. I’ve read annually, or every-other-year, should be expected from a rheumy. More often sounds like your doctor is investigating specific problems. At least, that’s my understanding based on what I’ve read (not based on any training in the field). If you keep your old EOBs, you could look back through them and figure out exactly when different parts were x-rayed.

@Tori – I think when you already had cancer, the stats don’t apply. It would be hard to figure out if it was something completely new due to excess radiation, or a recurrance of the previous issue.

@Wren – thank you. It’s weird that your rheumy hasn’t ordered any x-rays. It’s pretty standard to have baseline x-rays when you’re first diagnosed, then periodic checks after that to see if there’s visible disease progression. I think it’s standard to have a chest x-ray before beginning methotrexate. Mammograms count as radiation exposure, but MRI does not.

@Queen – If knitting is out for you (and it sounds like you’re really busy, so I’m guessint it is), check the hunting section at WalMart type stores for wool socks that don’t cost a fortune. Or Cabela’s for pricier options. I’d offer to make some for you, but already have quite a backlog for family members who want socks. Rice bags are nice, too, and work on more than just the feet. 😀

Kevin Md did a post about how imaging is driving up health care costs – didn’t get into xrays, but the more expensive MRI’s, CT’s and PET scans. 14% of ER visits involved this expensive imaging which was up about 4 times from about 10 years previously.

Although having a chest xray before starting MTX is recommended by the manufacters of MTX, it is not standard practice in the US that I’m aware of and I don’t believe the ACR has ever gotten around to making it a formal recommendation either. I believe the UK has proposed it as a guideline, but US doctors don’t necessarily side with UK rheumatology views, though I don’t know why.

My rheumy did not do a pre-MTX xray and admitted would not have done so without any outright respiratory symptoms as a reason to do so. I got my primary to order one, about a year after I’d started MTX.

Apparently, doing base line xrays of joints is not the norm either. My first rheumy did not do them. My current rheumy has only done them twice, at my request, but only of my hands/wrists. It’s been about six years since I’ve had those done. I’ve only been without insurance for about the last two. I could use new hand xrays, along with neck, shoulders and feet at least, I think. Hips might be able to wait a little bit. I’ve been very fortunate to not have my knees and elbows affected much that I’m aware of, even though these two areas were where I initially had some symptoms two years before I got officially diagnosed.

In fairness to my doc, I should say that I did wind up having other non-joint imaging done over the last ten years, and a childhood history of non-joint imaging done that do add to my cummulative radiation doses, and this m-a-y or may not have been taken into consideration. Although apparently the joint xrays aren’t going to add much risk to this.

The other point to take into consideration is whether or not the potential results of the imaging are going to change how your rheumy would treat you. I’m guessing my rheumy feels that the imaging results of the joints wouldn’t change the treatment plan which is also based on clinical examination and experience. This is a university doctor who also teaches and mentors. It is a well known university medical and research center, but the rheumatology department is not a centerpiece one, probably more ancillary.

My understanding is that base-line x-rays followed by periodic updates provides concrete evidence about how quickly the disease is deteriorating joints. The literature I’ve seen recommends them, but I haven’t searched ACR’s site.

My first rheumy did x-rays right there in his office and looked at them with me before my initial appointment was over. My current rheumy asked for copies of those base-line x-rays and compared them with the x-rays she ordered. She also had me get a chest x-ray before starting mtx. When she added enbrel she started to order another set of chest x-rays and I asked if I needed new ones already; it had only been six months so I didn’t have to repeat those.

You make a good point. If your treatment plan won’t change, then there’s probably no point in doing x-rays. But if there’s noticable progression, then x-rays give justification to 3rd party payers that more aggressive treatment is needed.